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NPI Code Detail

MEDICARE: MR. DALE ASHBY ELZIE LCSW

MEDICARE: MR. DALE ASHBY ELZIE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCSW003365GA
21041C0700XClinical Social Worker9003FL

General Provider Information

NPI Number : 1245332188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DALE ASHBY ELZIE LCSW
Provider Business Mailing Address
First Line : 4371 VERONICA S SHOEMAKER BLVD
Second Line : ATTN CREDENTIALING
City : FORT MYERS
State : FL
Zip : 33916-2216
Country : US
Telephone Number : 239-274-8200
Fax Number :
Provider Business Practice Location Address
First Line : 6420 W NEWBERRY RD STE 100
Second Line :
City : GAINESVILLE
State : FL
Zip : 32605-6622
Country : US
Telephone Number : 352-332-3900
Fax Number : 352-332-5009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2006
Last Update Date : 03/13/2020

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